Acupuncture appears to show results.

[Skeptic Ginger]

On the other hand, we could study placebos to determine what it is about them that seems to work. Then, apply those factors without the magical thinking http://www.sciencebasedmedicine.org/?p=90 One could hope to get the benefit without the risk.

As for "chiro" interventions for pain, those that work (mostly, spinal manipulation) are not chiropractic. Massagers and health care professionals get good results, that way, as well. "Chiropractic" is identification and "adjustment" of (imaginary) subluxations.

This (40 minute) video explains why it is safer to get neck manipulation from a health professional. [FONT=&quot]http://ph-ms.ouhsc.edu/ah/rehab/kinsinger.wmv[/FONT]
In short, professionals are more selective concerning who needs it, and better in their technique.

For the record, I would never recommend Chiropractic care nor acupuncture to a patient. I am against both. But I am also aware of what the research actually shows and drugs do have their own nasty side effects in particular dependence issues. So I am convinced I need to keep an open mind despite my personal skeptic biases.

 

[Skeptic Ginger]

....and a bit of irony:

There is no evidence that evidence based medicine improves patient outcomes.

Absolute nonsense!

I challenge you to compare the last 50 years of evidence based medicine to the previous 50 years of fledgling evidence based medicine and the thousands and thousands of years of no evidence based medicine that preceded the last century.

You have drawn an absurd conclusion.

 

[Skeptic Ginger]

... And a bit of irony: I would not wish to be accused of quoting you out of context- so there it is.

In the 1960s a friend of mine got the fatal diagnosis of Hodgkins lymphoma. In the 1970s, my cousin had that diagnosis, and he is (today, thirty years later) a healthy, robust, volunteer firefighter in his town. Evidence-based medicine has defanged many killers. Could you be any more ignorant, or was that a ham-handed attempt at comedy?

And I can list hundreds of conditions we have almost completely conquered with evidence based medicine as well as relate the story of my good friend who died at the age of 21 with Hodgkins.

Had he been born 21 years ago, he never would have died from his illness.

Prognosis for Hodgkins Lymphoma today

Overall cure rates for HL including all stages and all patients are around 75% to 80%. For young patients with early stage disease the likelihood of cure approaches 100%.

It breaks my heart to think about it.

 

[Skeptic Ginger]

Yes, I was laughing at myself because, to add a little more irony, I intuitively believe in Evidence Based Medicine.

My post was actually a paraphrase of something I read in the EBM guidelines linked to by Linda. They were published in 2001, so it may no longer be the case that "there is no evidence that Evidence Based Medicine works".

In reference to your particular case of Hodgkins Disease, there is probably not much dispute about how it should be treated. The EBV approach (in those guidelines) seems to be directed more at treatments that have been conventionally used based on intuition, experience, and knowledge of the pathophysiology of disease rather than on the results of clinical trials. Such treatments are likely to vary between individual clinicians, sometimes significantly. The EBM approach is an attempt to find out objectively what works in these cases.

(Seems smilies don't always work )

BJ

You are simply misunderstanding whatever it is you are calling evidence.

Double blind placebo controlled clinical trials are not the only form of evidence but even just going by those, we have evidence that evidence is the correct means of determining the best approach. It is not merely intuitive. That is an ignorant interpretation. It's like the ignorant outdated cliche' that medicine is an art not a science. No, it is a science.

 

[Skeptic Ginger]

I´m not sure that I understand what you mean by qualified. Is it to be understood as though you mean that the results of this particular study indicate a beneficial effect of acupuncture as a preventive measure of migraine attacks? If so, how does the use of drugs make it qualified?

The results of the study if correct, still only support acupuncture as an adjunct to medicine. Because the acupuncture was only tested with the medicine in addition, you cannot say anything about acupuncture alone. It is tempting to do so, but at this point, that is not what the study supports.

Again, I'm waiting for the full article to arrive in my email, so I am still going on the abstract alone.

 

[Ivor the Engineer]

Well given 100% of patients still die, I'd say EBM hasn't made any change to the outcome of patients.

The professionals who have saved more lives than all the doctors and nurses in the world put together are engineers. And we did (and do) it without the need to have the people we were (and are) helping look us in the eyes or thank us.

 

[Skeptic Ginger]

I have no problem sharing the credit, Ivor. But if you want to have a contest, bring it on. I'll take lives saved with antibiotics and vaccines and you take lives saved with improved water sanitation. The data on vaccines suggests rates of disease decline correlates with the introduction of vaccines more closely than with the introduction of potable water.

Now, if you could implement your engineering controls to include human behavior, then we'd have a real contest.

 

[BillyJoe]

Absolute nonsense!

Read out of context, of course it is nonsense!
But don't blame me, it is from Linda's link.

I challenge you to compare the last 50 years of evidence based medicine to the previous 50 years of fledgling evidence based medicine and the thousands and thousands of years of no evidence based medicine that preceded the last century.

They are user guides. That is the context you are missing.
They are talking about whether doctors using EBM have better patient outcomes than those who rely on traditional methods based on intuition, experience, and knowledge of pathophysiology. Apparently there is no evidence that they do.

You have drawn an absurd conclusion.

I am not drawing any conclusions, I have simply stated, perhaps a little too compactly, what was stated on that site. But my post was an obvious add-on to the post immediately before (as indicated by the "...and a bit of irony etc") which was directed to Linda regarding the link she posted for me to read.

 

[BillyJoe]

You are simply misunderstanding whatever it is you are calling evidence..

See above.

Double blind placebo controlled clinical trials are not the only form of evidence but even just going by those, we have evidence that evidence is the correct means of determining the best approach. It is not merely intuitive. That is an ignorant interpretation.

Well, again, I'm talking about the use of EBM by doctors and the outcomes for patients compared with the traditional approach.
Here is the link:
http://www.cche.net/usersguides/ebm.asp#Outcomes
(towards the bottom)

No, it is a science.

Or, perhaps more accurately, there is an art to the effective practice of science-based medicine.

 

[jli]

Again, I'm waiting for the full article to arrive in my email, so I am still going on the abstract alone.

Fair enough. The results reported in the abstract match those given in the article. The question is what we can deduce from the results. Two of the authors carry the title "Master of Acupuncture". I think it is reasonable to deduce that "Acupuncture given by someone who believes in acupuncture possibly show stronger effect than sham acupuncture given by someone who doesan´t belive sham acupuncture works". "Possibly" refers to the information (also given in the abstract) that a substantial number of patients dropped out. The article doesn´t explain why they dropped out. I can´t figure out what impact it would have on the results if the dropouts were caused by ineffectivity of treatment.

 

[Ivor the Engineer]

Water sanitation was just one example of how engineers save lives. Some more are: reliable supplies of energy, fast communication networks, roll cages, crumple zones, seatbelts and airbags in motor vehicles, vehicles in general and buildings that don't fall down.

And I haven't even mentioned anything medical engineers do yet...

 

[Skeptic Ginger]

...
They are user guides. That is the context you are missing.
They are talking about whether doctors using EBM have better patient outcomes than those who rely on traditional methods based on intuition, experience, and knowledge of pathophysiology. Apparently there is no evidence that they do.....

Well I challenge that conclusion. Going by what you have stated, you are claiming a comparison between physicians using double blind placebo controlled clinical trials and physicians using other evidence. You have made the false assumption that the difference was "evidence" when from the sound of it, the difference is in kinds of evidence.

 

[Skeptic Ginger]

Water sanitation was just one example of how engineers save lives. Some more are: reliable supplies of energy, fast communication networks, roll cages, crumple zones, seatbelts and airbags in motor vehicles, vehicles in general and buildings that don't fall down.

And I haven't even mentioned anything medical engineers do yet...

You cited sanitation and I replied with vaccines and antibiotics. You want to add other stuff, I'll add surgery and treatment of heart disease, lung disease, diabetes, cancer, etc etc.

Told ya I'd share the credit, but I'm not going to just concede.

 

[BillyJoe]

Well I challenge that conclusion.

As I said, the guidelines were written in 2001. Things might have changed.

Going by what you have stated, you are claiming a comparison between physicians using double blind placebo controlled clinical trials and physicians using other evidence.

I am not claiming anything. I am stating what the introduction to those guidelines claim. And they are not comparing different kinds of evidence. As I said, they are comparing doctors who use EBM methods - meaning those who do literature searches of clinical trails, evaluate those trials, and choose trials that will help them decide what treatments, tests, prognoses are appropriate for the patient in front of them - with doctors who use the more traditional methods of intuition, experience, medical texts, and knowledge of pathophysiology.

You have made the false assumption that the difference was "evidence" when from the sound of it, the difference is in kinds of evidence.

No.

 

[fls]

IE, do a proper study and it isn't likely to be rejected for publication on the sole basis the intervention studied isn't orthodox. So I'm unclear what you are saying Linda, did I misunderstand?

I meant that alternative medicine journals tend to be low impact journals. And that your qualifier ("IE, do a proper study...") tends to be the sticking point.

Linda

 

[fls]

Linda,

One early thought while reading bits of those EBV guidelines you linked to earlier:

It seems to me they are trying - with great difficulty - to close the barn door as the horses are actually bolting through it. If only those horses had been properly bedded down in their stalls in the first place....

Surely it's time for a massive effort to kill off the flawed clinical trial.

Isn't that what we've been talking about?

What makes you think that isn't what's happening?

Linda

 

[fls]

....and a bit of irony:

There is no evidence that evidence based medicine improves patient outcomes.

May I suggest that 'Evidence-Based Medicine ™' would have saved you some trouble?

Linda

 

[Ivor the Engineer]

You cited sanitation and I replied with vaccines and antibiotics. You want to add other stuff, I'll add surgery and treatment of heart disease, lung disease, diabetes, cancer, etc etc.

Told ya I'd share the credit, but I'm not going to just concede.

So on the rare occasions the electrical supply to a hospital fails, what happens? The emergency power supply kicks in and keeps the medical equipment (which is designed by engineers, BTW) running and the patients alive.

How many vaccines and antibiotics could be made if large parts of the manufacturing process had not been automated?

Treatment for cancer often requires precise doses of radiation to be targeted at the tumour site.

Diabetics can better manage their insulin requirements if they monitor their blood glucose level.

People with heart conditions can be treated and managed better if their heart performance is measured using such devices as ECGs and devices based on ultrasound/Doppler effect.

Engineers are working on artificial lungs (the Science Museum in London has a display of a prototype).

 

[Professor Yaffle]

Diabetics can better manage their insulin requirements if they monitor their blood glucose level.

I could reply with:

http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2008/04/18/ndiabetes118.xml

http://news.bbc.co.uk/1/hi/health/7352321.stm

But it appears it was another case of bad science reporting in the media.

http://www.nhs.uk/news/2008/04April/Pages/Hometestsfordiabetes.aspx

 

[Skeptic Ginger]

I meant that alternative medicine journals tend to be low impact journals. And that your qualifier ("IE, do a proper study...") tends to be the sticking point.

Linda

Well I don't read JAMA too often since I have to get them from the library, but JAMA was the journal I had in mind because I had read that article from '98 I had linked to. But I see a fair amount of CAM when I'm browsing PubMed.